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HomeMy WebLinkAbout4.l. Application for Payment - O'Leary's Hills 4th Addition � � , : GITY QF ROSEMOUNT APPLiCATION FOR PAYMENT NO. �� � CITY PROJECT NO� � 8�{- �f�/C4Y�":.j� SEH FI�,E NO: �E3 I ��' PRaJECT: �' j--Q S f.�, �l$ �,� ���� CONTRACTOR: �t Grfrnzp /��U Tso h• CONTRACT OATE: �����L�� ZOI "T�AvEi.C�' �>L APPLiCATIC?N AATE: 7��9�J ' �V2/VSVlGGcr,mrn Ss-337 FOR PERIQD ENDING; � �9' �� Total Contract Amount $ ��i7,S33�Z Total Amount Earned $ (S�] 3S?, 7� �__��.__._" � Material Suitably S�ored on Sita, Not Incorporated into Work $ Contract Change Order No. Peresnt Camplete $ Contract Change Order No. Percer�� Complete $ Contract Change Order No. Percent Com�lete , --__._ ,. .,�.+�.GROSS AMOUNT DUE ,.. . . . . .. . . . . . . . : : . . . . . . $—�Q?, �� 7 8 LESS S $ RETAINAGE . , . $ �j'� �� �� . . . . . . . . . . . . . . . . ----. AMOUNT QUE T4 DATE . . . . . . . . . . . . . . . . . . . $ f p�f }7 z 79 . � � , , � - LESS PREVIOUS APPLICATIONS . . . . . . . . . . . . $ """' AMOUNT DUE THIS APFLICATI�N . . . , . . . $ �I �''�Z 79. . . . . . � . � , . . . .. ,q���,. � h � � . . � . PP� Ep; ,• � , �'�• '� � , .,��,� ��.,�(' t�� . r" .7 3� g�, Richard M. i, City Enginee / irectar of Public Works � � _ A�PI,ICA'I'InN �ntt PAYMENT � .I`. � 1� 1 �j ��, +� •�' �- " .SHQRT ELLI0T1 t1EN�RiCK�t1N. INC. (UNIT PRICE CUNTRACT} Mo. � JUI� `��� ����� - - ,�;,,-�rnl��' � OWNER; CITY OF ROSEMOUNT QWNER'S PROJECT NO. ��� ENGINEER'S PRpJECT NO. $$174 L,QCATION: O'LEARY'S NILLS 9TN ADDITION ----__.._________ � � ..,��r�-• r , CONTRAC'I'OR RICHARD KNUTS(?N CONTRACT DATE 6�1r�r�g 201_TRAV�LERS_TR14IL_rSUITL_5sT_CONTItACT AMOUNT__SI6?_533.42____'^__ ' . 6URNSVILLE, MN 55337 - ��!_ �� ---------------------------- CONTR. FOR O'LEARY'S NILLS 4TH ADDITIC)N APPLIC.DATE 7/19/89------------------------------------ -------------------- ---------------------- PERIOD END. 7/19/$9 . .�'.°`. . APPLICATION FOR PAYNIENT DESCRIP�'ION CONTRACT QUANTTTY UNIT UNIT QUANTITY TO DAT� PRICE TOTAL ------------------- -------------------------------------------- SECTION 1 - SANiTARY SEWER ' ` 0256.40$ 8" PVC, 1Q'-12' DEEP L.F. 47� 575 9.08 $ 5,221.0,0 �256.408 g" PVC, 12'-14' pEEP L.F. 126 �?0 10.43 $ 1,773.Ip a256.408 S" PVC, 14' -16' DEEP L.F. 144 -- � 11.49 $ a �256. 514 12" RCP CL, V, 24' -26' L.F. 145 1�5 ' � " 25.73 $ 3,730.$5 DEEP �256.610 i0" DIP, 22'-24' UEEP L.F. 30 60 27.94 $ �,674.00 J256.610 10" UIP 2�!'-26' DEEP L.F. 476 645 . . . ."�''28.9? $ �8,685.65 3256.610 lQ" DIP, 26'-28' DEEP L.F. 20$ -- 30.1$ $ � ?AGE 1 OF 4 SHORT-�LLIpTT-}iENDRICKSt?N, INC. . � � G'256.701 STD. MANHOLE, 8' DEEP EACH 6 6 803.50 $ 4,$21. 00 / QZ56.'T02 EXCESS DEPTM STD MANEiOLE �,. F. 9Q 56. 45 . .�,_,., 4,�t.67 $ 2,747. 92 0256.706 MAN�iC?LE UROP SECTION L.F. 3p 29.01 �9.9'7 $ 2�,610.03 0256.802. 8„ X 4" PVC WYE �ACf� 17 17 1?.00 S 2�9.00 p256.802 10" X 4" DIP TE� EACEi 14 14 191.57 $ 2,68i.98 0255.803 4" PVC SERVICE L.F. 15Q0 1,275. � 4. 50 $ 5,739.75 025�.805 4" DIP RISEtt I,.F. 30Q 277 12. 1p $ 3, 351.70 0256.900 COM. TO EXISTING SEWER EACM 1 _ 1 183.00 S 183.OQ SECTION II - WATERMAIN 0257.406 fi" DIA WATERMAIN, CL. 52 L.F. 750 697 �,O�gQ $ 7,597. 30 p257.408 8" AIP WATERMAIN, CL. 52 I,.F. �.40a 1,455 12.39 $ �8,027. 45 0257.bOb 6" R.S. GATE VALVE & BOX EACH 2 2 _ 28�•5Q $ ���'QD 0257.608 8" R.S. GATE VALV� & 8QX EACli 3 3 400.00 S 1,�QQ•9Q 0257.630 FITTINGS LESS THAN 12" LB. 1000 �..510 1.54 S 2, 325. 4Q 025?.640 FIRE HYDRANT EACN 5 5 � 9Q7.6Q $ 4, 53�.R0 ,. ..i_e.. ... • Q25?.71Q 1" COPPER SERVICE L.F, 150Q 1,465 5.5U $ $,057 . 5� p25?.?30 1" CORPQRATION STOF EACH 31 31 1Q.40 S, 31U, �0 0257.740 1" CURB STOFa' � EACH 31 31 46.UU $ 1�426.Q_0 OZ57.806 INSULATION B.F. 20Q -- U.66 $ Q 0257.903 CON. TO EXl'STING WM. EACN 3 3 173.pQ � 5�.9.00 SECTION III - STORM SEWER 0258.4Q1 12" RCP C8 LEADS, CL V L.F. 12Q �5 25.79 $�5OQ.05 0258.412 1�" �tCP STORM SEWER, t,.F. 1$7 167 15.63 S 2,643.61 CI►. V 025$.415 15" RCP $TORM SEWER, L.F. 163 �-`�5 16.99 S 2s633. 45 CL. V 0258.6Q3 MANNOLE, TYP� 8 L.F. ? 7 74. 5? $ 521.99 025$.704 CATCH BASIN, TYPE X L.F. 20 13 '74. 10 S 963. 30 0258.801 R 1733 MH CASTING EACM 1 1 148.00 $ 148. 00 PAGE 2 OF 4 SNORT-ELLIOTT-liENDRICKSONf ING: '.,,'r'-•• � • � � � 0258.eos � 306� c�a chsTitvc �Ac� 4 4 i98.50 � 794.00 �._ 0258.920 GROUTE� RIPRAP, CL. ZII C.Y. 2 1. 5. . ' 30.50 $ 45. 75� -------.� Q258.921 GRANULAR FILTER MATERIAL C.Y. 2 1. 1 5.Op $ 5.50 --------- SECTION IV - STREETS . .�.,.. ., 2105. 501 COMMON EXCAVATTON C.Y, 50Q l.p� � 2105. 521 GRANULAR 84RROW (L.V. ) C.Y. 500 3.00 S 2111.501 TEST ROLLING R.S. 16 15.OU S� 2112. 5Q1 SUBGRADE FREPARATIQN R.S. 16 75.44 $ 2211.5Q3 AGG. HASE PLACED CL. � G.Y. 900 �,g� �r� 2341. 5Q4 BxT. MAT. FUR MIXTURE TQN 5� 13U.OU $ 2341.508 WEARING COUR$£ MIXTUR� TQI�t 475 9.35 $ �, .,�_�». .. , 2341, 510 BINDER COURSE MIXT[7RE TQN 47� 9.35 $ 2357.502 BIT. MAT. FUR TACK COAT GAL. 30Q 1.25 $ 2504. 602 AQJUST GATE"VALVE EACH 3 � -�____—__ 84.40 $ 2506.522 A�J FRAME & RING CASTING EACH '� 134. 14 S 2531.501 CQNCRET� CURH & GUTTER, L.F. 320p DES. D418 3.95 S SECTION V - LIG�iTING 2545.511 LIGNTING UNIT, TYPE A EACN 1 � 1493.UQ $ 2545. 51], LIGHTING UNIT, TYPE 8 EACH 3 1443.OQ S 2545. 532 UNi3ERQE20UNu CONUUC7'OR I,. F. 100U - -.__ .___ _ _m._ 2.7U S 2545.552 FEED POiNT EAC#I 3 �iio.00 s AGE 3 OF 4 SHORT-ELLIOTT-HENDRICKSON, INC. , .._�a,,,.. : , � , ' ' A�CaT I ON FQR PAYMENT - Con t i nue� - TUtal Contract Amount $ 1-67,533. 42 Total A►nount Earned $1Q7,339.78 Material Suitably Stored an Site, Not Incoporated into V�ork $ Contract Change Order No. Percent.Compiete � � Contract Change Order Plo. Percent Complete $ Contract Change Order tJo. Percent Complete $ GROSS A�UNT DUf. . . . . . . . . . . . . . . $ 1Q7,339.78 � IESS 5 �; RETAINAC�E. . . � 5,366.99 • -•---+ ,t•�.•r r�•. AMOUNT DUE TO pATE. . . . . . . . . . . . . $ 10].,972.?9 u .,��a. ... LESS P�EVIOUS APPI.ICAtIONS. . . . . $ '_ • • ANIOUNT DUE Tt#IS APPI IC11TI0N. . . . $ 10].,R72.7`9 CONTRACTOR'S AFFIDAVIT e undersigne Contractor hereb� swears under penalty of per,jury that (l) all previous pragress. payments received from the Owner,. on account 4f work performed under the contract referred to above have been applied by the undersigned to diseMarge in fu1T all obligatfons of the under- signed incurred in connection with work cavered by prior Applications for Pay�nt under said contract, and (2) all materiai and equipment incorporated in said Pro,ject or otherwise listed in or covered by this Appiicati.on for Payment are free and ctear af all liens, claims, security interests and encumbrances. Dated rL-�--�,;?�L-� . 19�( _ • RICHARD KNUTSON Gontr or , . ,� - , ��) By . �i�d'1.����/ . ame and Title �OUNTY OF �� � S� aTATE 4F , ,� � 3efore m�,on this � %• da vf � �g `� � ' � ' , �� personatly appeared nowr� to r�, w o being u y sworn, did depose �nd say that he is he ,� of the Contractor above mentioned; Office that he executed the above Application for Payment and Afftdavit on behalf of said Contractor; �nd that all of the sta� ne ts contained therein are true, correct and co l�te, A,A,A,�,IAAA/l,�j, „ Ny Coaxnission Expires:�,�; NM.V , ��, ,, �j �,•' ��'�'�-MMr�oar�ta . �, g,• � p� .�^''�n Coun�y ,' o ta ry P c, , � TMe undersigned has che� ed t e���'���4��.� ation for Payment shown above. A part of tt�is Apptication is the Contractor's Affldavit statfin9 that ail previous paymenCs to him mder this Contract have been applied by him �to diseharge fn fu11 aTl of h1s obligations in :annectfion with the wor'k covered by att prior Appiications for Payment. (n accordance with the Contract, the undersigned approves payment to the Contractor of the amount Due. � � /S 4 SHORT E T NEN CKSfI I )a te �� S Y 'age _ << of 4 � • CITY QP ROSEMOUNT APPLICATION Ft?R PA�i'MSNT NO. � CITY PROJECT NO: I S¢ ��'���`��� SEH FILE NO: C.�� � �'�- PROJECT: _ C�� I--�a�v.t S I-�+ ��S �� l7�caD k. CONTRACTOR: �t GrF�ft4 kW U'f�o�, eONTRACT pATE: ��I S� I S 9 �� T��-� ?��C. APPLICATIQN DATEs �L�g��9 �U21USVlCG�,1�1li!.$'�'3�7 F�R PERIOD ENDING: � f 9�� T 'rotal Contract Amount S /67 533 4=z Tota1. Amount Earned S_I(�?, �39, �$ Ma�erial Suitably Stored on Site, Not Incorporated into Work � Contract Change Order No. Percent Complete � Contract Change Order No. Percent Complete $� Contract,. Chamge Order No. Peraent Com�lete � GROSS AM4UNT DUE . . . . . . . . . . . . . . . . . . . . . . $ 1 CC��J�3S 9' �8 � � LESS S $ RETAINAGE . . . . . . . . . . . . . . . . . . . $ S3 E�6 9� AMOIJNT DUE TO DATE . . . . . . . . . . . . . . . . . . . . $ �O I, g'7 2 7 A LESS PREVIflUS APPLICATIQNS . . . . . . . . . . . $ '—"" AMOUNT DVE THIS APPLICATION . . . . . . . . . . . $ J4), �7� .79 f .. VED: � � t ,�C'� "".�,�' .7�3��� ichard M. ti, C�.ty Engine /Director of Public Works . ' • a .._��,,,.: , APPLI�ATION FOR PAYMENT .R �, � �, I � � � (UNIT PRIC� CpNTRACT) ' SHORT ELtiQTT MENDRIClfSflM, tNC. NQ. 1 .�U� w� ��g� � OWNER:----lCITY_OF_RQSEMULINT-------___....,_OWNER'S PROJECT NU.___�_ 1$4___..__ _--_ ENGINEER'$ FROJECT Np. $8174 I L,OCATZON: O'LEARY'S HILLS 4TH ADpITION '- - ------_____ CONTRACTOR RICNARD KNUTSpN CONTRACT DATE ���5��9 ------------------- ------------------------- • 2d1 TRAVFLERS TRAiL, SUITE 5 CONTRACT AMOUNT $I6T,533.42 BURNSVILLE, MN 55337----- --- ----------------------- �pNTR. FOR O'LEARY'S NILL3 4TH AQDITIIJNT ----------------------------- ----------------------------------- 4PPLTC.DATE 7/19/89 PERIOD END. ?/],9/89------�----� APPLICATION FOR PAYMENT DESCRIP�!'ION CONTRACT QUANTITY UNIT UNIT QUANTITY TO DATE PRICfi TOTAL ------------------- --�--------- -------- ------------------------- SECTION 1 — SANITARY SEWCSR 0256.4Q8 8" PVC, 10'-I2' DEEP L.F. 475._ . 57� g.0$ $ 5,221 . 00 1256.408 8" PVC, 12'-14' D�EF L.F. 126 170 10.43 $ 1,773 .10 )256.40� 8" PVC, 14'-16' DEEP L.F. 144 -- 11.49 S � 7256.514 12" RCP CL. V, 24'-26' L,F. 145 145 �r3,73 $ 3�730.$5 DEEP )255.610 10" DIP, 22'-24' DEEP L.F. 30 6Q 27.90 $ 1,674. Qp )256.610 10" DIP 24'-26' DEEP L.F. 476 645 28.97 $ 18,685.55 , )256,610 10" DIP, 26'-28' DEEP L.F. 208 -- 30.1$ S Q ' ..�_,�.. . . 'AGE 1 OF 4 $HORT-ELLI4TT—NENDRICKSON, INC. G�Sb.701 STD. MANHOLE, 8' D�EP EACN 6 6 803.5Q $ 4,821.00 0256.702 EXCESS OEPT� STD MANHOLE L.F. 90 56.45 4g,6� g 2,747. 42 0256.706 MANHOLE DROP $ECTION L.F. 30 29•Q1 89.97 $ 2,610.p3 0256.801 8" X 4" PVC WYE EACH 1? �? 17.fl0 S 2$9.00 --�.. 0256.$02 10" X 4" DIP TE8 EACH 14 14 191.57 $ 2,6$1 .98 Q256.803 �" PVC SERVICE L.F. 1500 1,275. 5 e�.5p $ 5,739.75 0256.805 4" DIP RISER �,.F. 3Qp 277 12. 1Q S 3, 351.74 0256.900 CON. TO �l�fi�5TYNG SEWER EACM ' 1 1 183.00 $ 183, 00 SECTION II - WATERMAIN 0257.4U6 6" DIP WATEftMAIN, CL. 52 L.F. ?5Q 6�� 1Q.90 $ �,597. 30 0257.40$ 8" DIP WATERM,AIN, CL. �2 L.F. 1400 1r455 �2.�9 $ �$�Q27. 45 Q257.606 6" R.S. GATE VAI,VE & BOX EACi�i 2 2 28?.SO $ 575.Q0 0257.608 S" R.S. GATE VALVE & 80X EACH 3 3 400.OU $ 1r200.00 0257.630 FITTINGS LESS THAN 12" LH. lOQO 1,510 1.5� $ 2,325, 40 0257.64Q FIRE HYDRANT EAGH 5 � 907.b0 $ 4, 538. 0� 0257.710 1" CpPPER SERVICE L.F. 150Q 1,465 5.50 S 8,OS7. 50 0257.730 1" CORPORATION STOP EACH 31 31 10.00 $ 310. 00 0257.74Q 1" CtTRB STOP EACN 31 31 46.QO S 1 �426.00 0257.$06 � INSULATION B.F. 200 - Q. 66 � Q . . 025?•9a3 CON. TO EXISTING WM. EACH 3 3 1?3.OfJ $ 519.00 SECTION III - STORM SEWER 0258.401 12" RCP CB LEADS, CL V L.F. 120 95 15.79 $ 1, SQQ,05 Q258.412 12" RCP STORM SEWER, L.F. 167 167_ 15:$3 � . 2.643.61 CL. V 0258.d15 13" RCP STtJFtM S�WSR, L,F`. 163 � 155 1�5.99 8 2 633.45 CL. V � . a ._�a.;,.:: � � �258.603 MANHOLE, .TYP� H L.F. 7 7 ?4. 57 S 521.99 �258.?04 GATCH BASIN, TYFE X L.F. 20 1� 74.10 $ 963 . 30 �258.$(J1 R 1733 MH CASTING EACM 1 � : �,q8.00 $ 148•00 PAGE 2 OF 4 SHORT-�LLIOTT-HENDRICKSQN, INC. . - 0258.808 R 3067 CB �CASTINt3 BACN 4 4 1gg.g0 g ?94•00 --------__,_ 0258.920 GROUTED RIPRAP, CL. III C.Y. 2 1.5 3p.�0 � 45.75 0258.921 GRANULAR FILTER MATERIAL C.Y. 2 1.1 g,pQ � 5. 50 SECTION IV - STREETS 2105.501 COMMON EXCAVATION C.y. 500 1.Q1 $ ---------�-- 2105.521 GRAN�TLA� B�RROW (L.V. ) C.Y. 500 3.00 S 2111.501 TEST ROL�,ING R.S. 16 15.OU $ ----.-- 2112.5Q� SUHGRADE PREPARATiON R.S. lb 75,44 S -�, 221�1.503 AGG. B1�S� PLACED CL. 5 C.Y. 90Q ?.91 S 2341.544 BIT. MAT. FOR MIXTURE TON 55 13D.Q0 $ 2341.508 WEARING COURSE MIXTURE TON 475 g.�� $ 2342.510 BIP�iDER C�URSE MIXTURE TON 475 g,3g � --.�. 235?.502 BIT. MAT. FOR TACK GQAT GAL. 3OQ 1 .25 $ . . 25Q4.602 ADJUST GATE VALVF EACH 3 � � aa.Qo s 2505.522 �DJ FRAMB � RIl+JGi CA$'t'�INGt LACK 7 �.39. 14 3� -�.,,.......�.. 2531.'S01 CONGRE'i'E C'��t�' 6� GUTTC�R, �L.F. 32�0 DES. D418 3.4�' $ SECTION V - LIGHTING 2545.511 � LIGNTING UNiT, TYPQ A EACH 1 --�—_.� 1493.UtJ $ 2545.511 LIGHTING UNIT, TYPG H EACH 3 1493.00 S 2545.532 UNDERGRQUND CONDUCTOR L.F. 1Q00 2.70 $ 2545. 552 FEED POINT EACt3 3 211U.Q0 $ AGE' 3 OF 4 SHORT-�LLIQTT-HENDRICKSDN, ING. � APPLIC�TION FOR PAYMENT - Continued 4 • Tutal Contract A�unt $ 167,533. 42 Total An�unt Earned $107,339.78 Materiat Suitably Stored on Site, Not Incaporated into Work $ Contract Change Order No. Percent_Complete � Contract Change Order ilo. �ercent Complete $ Contract Change Order t�o. � Percent Complete $ GR05S Ah�UNT DUE. . . . . . . . . . . . . . . $ 107,339.78 LESS S % RETAINAGE. . . . . . . . . E 5, 366.99 At�UNT OUE T4 DATE. . . . . . . . . . . . . $ 101,972.79 LESS PREVIOUS APPLICAtIONS. . . . . � _� . AMOUNT OUE 7HIS APPLICATIUN. . . . $ 101,972.79 CONTRAGTOR'S AFFIDAViT he undersigned Contractor hereby swears under penalty of perjury that (1) all previous progress. payments received from the Owner on account af work performed under the contract referred to above have been applied by the undersiqned to discharge in full ail obligations of the under- signed incurred in co�nection with work covered by prior Applications fvr Payment under sa9d contract, and (2) a11 � materiai and equipment incorparated in said Project or otherwise iisxed in or covered by this App�ication for Payment are fr�e and clear of a11 Tiens, claims, seeurity interests and encumbrance5. �.- .�y� ,�� � Dated -----���;�-,` . 19��. RICHARD KNUTSON ` ` Contr or . By �:�'Ll'�=-'' �` - am and Title �OUNTY OF . � , � SS iTATE OF , , ' �� 3efore me,on this % , 19 ��� � . da of � persanally appeared ' ' �'� ' � " nown to me, w o being duly swarn, did depose �nd say that he is he of the Cantractor above mentioned; ce that he executed the above Application for Payment and Affidavlt on behalf of said Contractor; �nd that all of the sta e ts contained therein are true, correct and com�lete. ' AA�1 � , ,, ' � Hy Commi s s i on Exp i res�4 •' w . N M.V �J ��-4 ��'b�c-Mmnesota • Notary i c ., '�n �nty the undersigned has chec' ed the��i�"t:�`��r tion fvr Payment shown above. A part of this Application is the Contractor's Affidavit stating that a11 previous payments tv him �nder this Contract have been a�plied by him to discfiarge in futl ai1 of his obligations in �onnection with the work covered by all prior Applications for Payment. In accordance with the Contract, the undersfgned approves payment to the Contractor of the �mount Due. .� /�,�, /8� SMORT E T HEN CKSO I )ate t ( $y �a9e 4 0# 4